Originally Posted by Oerets
Or keep working at a job just to keep coverage due to a now Pre Existing Condition.
First of all, the very notion that an insurance product is the right way to go fund individual's health care needs is, to me, insane. Such a system treats incurring health claims the same as auto insurance claims: you have claims, and your rates go up. It is inhumane to those who truly have health conditions that are serious. Yet, it also empowers those who refuse to take care of their bodies by smoking, drinking excessively or eating junk, because it allows them to sustain that lifestyle while dumping the financial consequence for their poor decisions on other individuals in their group (assuming their on a group policy). If they are on an individual policy, these may be some of the folks that, over time, an insurance company might deem a bad risk and terminate their coverage.
Certainly the profit motive that drives many insurance companies grates folks the wrong way. But here in MI, I can also say that Blue Cross Blue Shield of MI is the dominant carrier in the state with over 70% market share, and their rates are no better, and often more expensive (albeit with slightly richer plan designs overall) than for-profit carriers that operate in the state. BCBS is also a regulated entity, as they are the "carrier of last resort" in the state: they cannot refuse to write a policy for anyone who wants one, even if other carriers deem the group to be a high risk refuse to write a policy. Now, that person / group might not like the cost of premium that BCBS assigns to that person / group for coverage, but they still cannot refuse to write a policy.
I don't know that I've got great solutions to this. Medical costs are escalating for many reasons, largely driven by increasing demand for medical services and pharmaceuticals. There's little in our current system of covering costs with insurance for those under group policies that serves as a check on demand, assuming that individuals / businesses can afford to pay the premiums. Employers have been introducing additional cost sharing measures for years in response to rising premiums: increasing deductibles, increasing co-insurance, reducing coverage for certain services. This helps keep a check on demand while keeping the product affordable for both the employer and the employee. However, with cost of care continuing to rise, this cannot be viewed as a long term fix.
Obamacare does very little to address the rising cost of care. It does nothing to address increasing demand for medical care. By adding taxes to medical devices and services starting next year, and adding taxes to health insurance plans by 2018, it will actually add to the increasing cost of care.
Also with Obamacare, the jury is out on the impact the mandate will have. As you know, both businesses who fail to offer coverage and individuals who fail to purchase coverage will be assessed a $2000 annual tax penalty. From my perspective, the tax penalty may have the opposite effect of encouraging business to offer coverage, particularly since a relatively modest group medical insurance policy costs much more than $2000 / year (and that doesn't include the costs of administering the policy).
For me, a solution starts with getting rid of shielding individuals from their actual cost of care. It also must get rid of a system that relies on insurance to cover the cost an individual's medical costs from the first dollar. I would be in favor, however, of a system that insures an individual from "catastrophic medical care expenses."
Getting a third party, whether the insurance company or a government agency, out from between the doctor and the patient would produce significant gains in efficiency. It would be an evolutionary step to make individuals responsible for the payment of their own medical expenses. Doctors began accepting direct payment from insurance carriers as a convenience to their patients. Given the evolution of Medicare and multiple insurance companies with vast differences in how they reimburse, I think that practice can be kicked to the curb. It might give traction to businesses that helps individuals manage insurance claims and expenses, while working to keep them healthy. There are already businesses out there that provide services like these.
If we must go the route of insurance, or an insurance - like product, then I think a mutual insurance company should be the only insurance carriers that are allowed to offer medical coverage. Mutual insurance companies are owned by the policy holders. Any premium charged in excess of claims cost are refunded to the policy holders. Of course, policy holders also pay premiums in accordance with claims incurred, so they have some direct "skin in the game" to help control the cost of coverage.
Also, rather than create a vast and imposing bureaucracy to manage the delivery and cost of health care in this country, it would seem to me a far more efficient route would be to provide a tax rebate or deduction for actual medical costs incurred: either dollar for dollar or a percentage of claims costs. This assumes that we all agree that "we the people" are all in agreement that we have a shared responsibility of keeping ourselves healthy, as well as the guy next door. However, under such a system, if the guy next door drinks booze, snorts coke and eats Cheetos all day, then I'd want such a system to reimburse him less for his expenses.
I thing High Deductible Health Plans / Health Savings Accounts have been a missed opportunity. A health plan with high deductibles that is attached to a savings vehicle that allows individuals (and employers) to place money tax deferred or tax free into an account that bears interest and is a source of funds to cover medical care costs is a good idea, but doesn't come without some risks.
There are folks who are much smarter than I am out there who can likely bring more and better ideas to the table. But maybe for conversation purposes, this is enough for now.